Unit 2: Nursing Care
of Clients with Altered
Ventilatory Functions
Eric Lahaman Astillero, RN, MN, EMT
Nursing Director – West Metro Medical Center
American Heart Association Instructor
BLS, ACLS, Disaster & National Emergency Instructor & Assessor
Unit 2: Outline
COPD
Pulmonary
Pneumothorax Embolism
Care of
Client with
Pulmonary
Hypertension Altered Respiratory
Failure
Ventilatory
Functions
Respiratory
ARDS
Pandemics
Pneumonia
What is COPD
Chronic Obstructive Pulmonary Disease, or COPD, is a serious
lung condition that obstructs airflow, making breathing
difficult.
It's primarily caused by long-term exposure to harmful
substances, especially tobacco smoke.
Types of COPD
1. Chronic Bronchitis – a chronic inflammation of the lower
respiratory tract characterize by excessive mucous
secretion, cough, and dyspnea associated with recurrent
infections of the lower respiratory tract.
2. Emphysema – a complex lung disease characterized by
damage to the gas – exchanging surfaces of the lungs
(Alveoli)
Types of COPD
CHRONIC BRONCHITIS
• Chronic bronchitis is a disease of
the airways and is defined as the
presence of cough and sputum
production for at least 3
months in each of 2 consecutive
years.
• Also termed as “blue bloaters”.
• Irritate the airways and leads to
the production of sputum
EMPHYSEMA
• Pulmonary Emphysema is a pathologic
term that describes an abnormal
distention of airspaces beyond the
terminal bronchioles and destruction of
the walls of the alveoli.
• also called “pink puffers”.
• There is impaired carbon dioxide and
oxygen exchange,
• There are two main types of
emphysema: panlobular and
centrilobular.
Nursing Diagnosis
1. Ineffective breathing pattern related to chronic airflow
limitation.
2. Ineffective airway clearance related to bronchoconstriction,
increased mucus production, ineffective cough, possible
bronchopulmonary infection.
3. Risk for infection related to compromised pulmonary
function, retained secretions and compromised defense
mechanism.
Assessment and Diagnostic Findings
1. History Collection
2. Pulmonary Function Studies
3. Spirometry
4. Arterial Blood Gas
5. Chest X-rays
Clinical Manifestation
The natural history of COPD is variable but is a generally
progressive disease.
• Chronic cough.
• Sputum production.
• Dyspnea on exertion.
• Dyspnea at rest.
• Weight loss.
• Barrel chest.
Complications
1. Respiratory Failure
2. Pneumonia & Respiratory Infection
3. Right-sided heart failure
4. Pulmonary Hypertension
5. Pneumothorax
6. Skeletal Muscle Dysfunction
7. Depression and Anxiety Disorders
Objective of Management for COPD
The main objective of COPD Management are the
following:
1. Relieve symptoms
2. Prevent disease progression
3. Reduce mortality & improve exercise tolerance
4. Prevent and treat complication
Medical & Pharmacologic Management
1. Risk reduction: Smoking cessation
2. Bronchodilators (MDI)
3. Corticosteroids
4. Vaccines
5. Oxygen Therapy
Surgical Management
1. Bullectomy
2. Lung Volume Reduction Surgery
3. Lung Transplantation
Nursing Priority
1. Maintain airway patency.
2. Assist with measures to facilitate gas exchange.
3. Enhance nutritional intake.
4. Prevent complications, slow progression of condition.
5. Provide information about disease process/prognosis
and treatment regimen.
Nursing Responsibilities & Management
1. Health Teaching
2. Administer Bronchodilators and Corticosteroids
3. Direct or controlled coughing
4. Inspiratory muscle training
5. Diaphragmatic breathing
6. Pursed lip breathing
7. Manage daily activities
8. Exercise training
9. Walking aids
Unit 2: Outline
COPD
Pulmonary
Pneumothorax Embolism
Care of
Client with
Pulmonary
Hypertension Altered Respiratory
Failure
Ventilatory
Functions
Respiratory
ARDS
Pandemics
Pneumonia
What is Pulmonary Embolism
Pulmonary embolism is
a common disorder
that is related to deep
vein thrombosis (DVT)
Classification
Most commonly, pulmonary embolism is due to a
blood clot or thrombus, but there are other types of
emboli:
1. Fat Emboli
2. Air Emboli
3. Amniotic Fluid Emboli
4. Septic Emboli
Causes
Pulmonary embolism is linked to a lot of
causes and these are the most common:
1. Trauma
2. Surgery
3. Hypercoagulable States
4. Prolonged immobility
Clinical Manifestation
Symptoms of a pulmonary embolism depend on the
size of the thrombus and the area of the pulmonary
artery occluded by the thrombus:
1. Dyspnea
2. Chest Pain
3. Tachycardia
4. Tachypnea
Assessment & Diagnostic Findings
Death from PE commonly occurs within one (1) hour
after the onset of symptoms; therefore, early
recognition and diagnosis are priorities:
1. Chest X-ray
2. ECG
3. ABG Analysis
4. Pulmonary Angiogram
Medical & Surgical Management
Pulmonary Embolism is often a
medical emergency, emergency
management is primary concern.
1. Anticoagulation Therapy
2. Thrombolytic Therapy
3. Surgical embolectomy
4. Transvenous catheter
embolectomy
5. Interrupting the vena cava.
Nursing Assessment Nursing Diagnosis
1. Health History 1.Ineffective peripheral tissue
2. Family History perfusion related to obstructed
3. Medication record pulmonary artery.
4. Physical Exam 2.Risk for shock related to
5. D-Dimer Test increased workload of the right
ventricle.
3.Acute pain related to pleuritic
origin.
Nursing Interventions
Nursing care for a patient with pulmonary embolism
includes:
1. Prevent venous stasis.
2. Monitor thrombolytic therapy.
3. Manage pain.
4. Manage oxygen therapy.
5. Relieve anxiety.
Unit 2: Outline
COPD
Pneumothorax
Pulmonary
Embolism
Care of
Client with
Pulmonary
Hypertension Altered Respiratory
Failure
Ventilatory
Functions
Respiratory
Pandemics ARDS
Pneumonia
